{
"Npi": {
"NPI": "1255644423",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MOREIRA-WILSON",
"FirstName": "OLUKEMI",
"MiddleName": "ANTONIA",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MOREIRA",
"OtherFirstName": "OLUKEMI",
"OtherMiddleName": "ANTONIA",
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "PA-C",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "5306 BROADWATER ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TEMPLE HILLS",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20748-5871",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "202-425-0740",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9135 PISCATAWAY RD STE 300",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CLINTON",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "20735-2554",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "800-910-1742",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/16/2010",
"LastUpdateDate": "09/29/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "PA031357",
"LicenseNumberStateCode": "DC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "0110003287",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "C0004263",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}